Vote affirms mental-health Medicaid cap for Arkansans

Legislative Council upholds group-therapy rule change

About 10,000 Arkansans who receive group-therapy services through Medicaid will be limited to 25 one-hour sessions a year under a rule change that will take effect next week.

An effort to rescind legislative approval of the change failed Friday for lack of enough votes.

Previously, the state's Medicaid program had no limits on the number of sessions and paid for daily sessions of up to 90 minutes.

Opponents of the rule change say it will disrupt patient care and cause facilities to close.

Proponents, including state Medicaid Inspector General Elizabeth Smith, say it will save the state money and improve care by discouraging providers from excessively using or billing for the service.

Smith cited a report showing that, from 2013-15, Arkansas' Medicaid program spent $147 million on group psychotherapy, more than six times the amount spent on the service by the Medicaid programs in Alabama, Georgia, Louisiana, Mississippi, Tennessee and West Virginia combined.

AdvanceMed, a company with a federal contract to monitor Medicaid and Medicare spending in Arkansas and six other states, found that Arkansas could have reduced Medicaid spending by $31.5 million between 2013 and 2015 if it had capped group-therapy sessions at one hour, and $70 million over the same period by limiting therapy sessions to 25 per year.

The company also found that Arkansas' reimbursement rate, $55.20 per hour, was higher than in Louisiana, Georgia and Mississippi. Information on the rate wasn't available for Tennessee and West Virginia, where AdvanceMed also monitors Medicaid spending.

Smith has proposed lowering Arkansas' reimbursement rate to $40 per hour, which AdvanceMed found would have reduced spending from 2013-15 by $40.5 million. That change is expected to go to the Legislative Council for approval later this year.

Robin Raveendran, director of the Alliance for Health Improvement, which represents mental-health-care providers, said Friday that any savings from limiting group therapy will be offset by costs in other areas.

For instance, he said, more patients will wind up at the Arkansas State Hospital, in hospital emergency rooms or in jail as providers close facilities or accept fewer patients.

"It will be an expensive problem for the state," Raveendran said.

Smith said Beacon Health Options, a company that reviews coverage requests for the state Medicaid program, can grant exceptions from the therapy limits if they are medically necessary.

Excessive spending puts the state at risk that the federal government, which provides 70 percent of the funding for most Medicaid benefits, could seek reimbursement from the state, she said.

"My concern was the integrity of our program," Smith said Friday. "What we need to do is begin to turn the tide."

The chairmen of the Legislative Council called a special meeting Friday to consider rescinding the council's Sept. 23 vote establishing the therapy limits that some legislators said was confusing.

Marty Garrity, director of the Bureau of Legislative Research, said Sen. Bill Sample, R-Hot Springs, and Rep. David Branscum, R-Marshall, called the meeting after receiving written requests from a majority of the council's 60 members.

But a motion to rescind the vote received only 13 favorable votes Friday from the council's House members.

Passage would have required favorable votes from two-thirds of the council members from each chamber -- 22 of the 32 House members and 19 of the 28 Senate members.

Before the vote, Garrity told lawmakers it wasn't clear whether council even had the authority to rescind its approval of the rule implementing the group-therapy limit, which was filed Tuesday with the secretary of state.

Whether and when the Legislature can rescind its approval of a rule isn't spelled out in state law or the state constitution's Amendment 92, which gave lawmakers the final say over such rules and hasn't been tested since voters approved the amendment in 2014, Garrity said.

The vote on the rescission came after a motion by Sen. John Cooper, R-Jonesboro, to allow testimony about the therapy limit failed in a voice vote.

"It baffles me that we want to close the door on information," Cooper, who opposed the benefit limit, said after the meeting.

The change takes effect Oct. 7 -- 10 days after the filing with the secretary of state.

During last week's Legislative Council meeting, Bonnie White, executive director of Jonesboro-based Mid-South Health Systems, said the group-therapy limit would force her organization to close its three 16-bed facilities for people who have been acquitted of crimes because of mental illness.

She and other provider representatives had asked that the rule's implementation be delayed until July 1, when the state Medicaid program plans to begin providing a daily reimbursement rate for such facilities as part of an overhaul of its behavioral health reimbursement rules.

On Friday, Ruth Allison Dover, Mid-South Health Systems' chief operating officer, said she hopes to meet with Department of Human Services officials to explore other ways to provide revenue to keep the facilities open.

"This rule completely obliterates our ability to take care of that population," Dover said.

A Section on 10/01/2016